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With opioids, progress leads to dilemmas

By Todd Feathers, tfeathers@lowellsun.com

Updated:
09/18/2016 09:47:04 AM EDT

The special section inside today s newspaper looks back on what has been done over the past 2 1/2 years to combat the opioid epidemic, profiles people who are fighting in the trenches and highlights lingering problems.

At least 6,258 Massachusetts residents fatally overdosed in the decade before former Gov. Deval Patrick declared opioid addiction a public-health emergency, on March 27, 2014.

That date was supposed to mark a turning point in the epidemic, and in many ways it has:

* Doctors are now required to undergo more training around addiction and they are limited in how many opioids they can prescribe to first-time patients.

* Insurance companies are mandated to provide 14 days of addiction treatment.

* The life-saving drug naloxone (Narcan) is widely available to first responders and ordinary people.

* The number of treatment beds has increased and so has the amount the state reimburses recovery programs.

Perhaps most importantly in the day-to-day lives of opioid users and their families, it has become less taboo to discuss the subject. The state has collectively begun to realize how widespread the problem is.

But the key metric -- the number of fathers, mothers, sons and daughters who have died -- has only gotten worse.

In the 2 1/2 years since Patrick declared the public-health emergency, nearly 4,000 people have fatally overdosed.

Their medical care has burdened hospitals and public safety agencies and many of their children have become wards of the state, putting even more pressure on an already overwhelmed Department of Children and Families.

Those who do manage to break their addictions find themselves with limited options in their recovery.

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Sober housing is scarce and often poorly maintained. Many employers remain hesitant to hire former addicts.

"I've never seen anything that was so dispersed -- it was pretty much everywhere you went -- and it was growing and has been growing at such a rapid clip with so much momentum in it," Gov. Charlie Baker said. "And one of the things I said (during the 2014 campaign) is we're doing a lot of good things, but it's going to take awhile to actually bend the trend, and my concern was what would happen in the meantime. I hate the fact that the numbers in 2015 ended up being as bad as they were, but given what we all saw in the trend data in the previous three or four years, we shouldn't have been surprised."

It has become a mantra among legislators and public-health workers that the epidemic will get worse before it gets better.

Many people who become addicted to opioids start with prescription pills, obtained legally from a doctor or otherwise, and the number of opioid prescriptions in the U.S. rose consistently until it hit a peak of 282 million in 2012, according to IMS Health data.

The average person first takes a prescription opioid at age 21, the average heroin user starts taking the drug at age 28, and most overdoses come between the ages of 25 and 54, according to the Substance Abuse and Mental Health Services Administration.

That means it could be decades before the full ramifications of the country's prescription opioid and subsequent addictions come to bear.

"We've been dealing with this (opioid addiction), this force of nature, since the 1800s," said Maryanne Frangules, executive director of the Massachusetts Organization for Addiction Recovery. "It's not going to be in the next year that we see a turnaround ... I'm trying to be as realistic as possible, but at the same time I'm feeling this whirling dervish of all these things that are happening."

Even as the state makes progress, it leads to new dilemmas. A relaxing of the stigma around addiction and improved access to treatment means more people are seeking help, but that just contributes to the shortage of space in recovery programs.

New limits on prescription opioids should help reduce the number of pills that are left lying around in medicine cabinets, but they may also make it harder for people who really need the medications to get them.

And perhaps most worrying, deadly synthetic opioids such as fentanyl and carfentanil -- a tranquilizer for zoo animals that has caused waves of overdoses in other states -- are flooding drug markets and making heroin look like a weak substitute.

The state government and local organizations have devoted significant resources toward education programs to ensure that the next generation does not fall into opioid addiction the way current 25- to 54-year-olds have.

But much work remains to be done if those who are currently addicted can hope to enter and stay in recovery for the rest of their lives.

"We need to start looking at the housing piece, we need to look at the education side of it," said state Sen. Jennifer Flanagan, a Leominster Democrat who chairs the Joint Committee on Mental Health and Substance Abuse. "We need to start looking at what happens to people when they get out of detox and treatment because people need to live their lives."

The special section inside today's newspaper looks back on what has been done over the past 2 1/2 years to combat the opioid epidemic, it profiles some of the people who are fighting in the trenches, and it highlights some of the problems that still remain.

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